Claims and Benefits Specialist

Working hours: 13.30-22.00 (Mon-Fri)

Start date: 1st November 2024

Contract limited to 1 year (possibility to extend)

About Accolade

Accolade (Nasdaq: ACCD) provides millions of people and their families with an exceptional healthcare experience that is personal, data driven and value based to help every person live their healthiest life. Accolade solutions combine virtual primary care, mental health support and expert medical opinion services with intelligent technology and best-in-class care navigation. Accolade’s Personalized Healthcare approach puts humanity back in healthcare by building relationships that connect people and their families to the right care at the right time to improve outcomes, lower costs and deliver consumer satisfaction. Accolade consistently receives consumer satisfaction ratings over 90%. For more information, visit accolade.com.

You will be a part of a large team of open-minded professionals with diverse backgrounds and experience. You will join a dynamic work environment and have colleagues from all over the world. In your role, Claims & Benefits Specialist are primarily solving inbound tasks and instant messages from our internal team and resolve complex cases regarding claim, benefit, and eligibility issues by using internal tools, health plan insurance systems, and coordinating with our health plan partners.

A day in the life…

• Act as a trusted partner for complex claims and benefit questions and issue resolutions.

• Act as a liaison to our health plan partners and providers in solving complex claims and benefit issues.

• Educate our internal teams by helping them better understand claims and benefit questions/issue resolution and support ongoing training/learning with frontline employees.

• Collaborate with teammates, member services teams, health plans, and providers to deliver the best possible service experience for clients of the company

• Handle claim disputes with partner health plans on behalf of the client.

• Liaise with our Health Plan partners via phone call several times per day to investigate and resolve member issues.

• Ensure compliance with internal and external health plan partner business processes.

• Develop and maintain solid working relationships and processes with health plans and other payors.

• Support internal teams with eligibility, benefits, and claims questions and/or issue resolution, including understanding the root cause of the issue.

• Listen, assess, and comprehend the clients’ presenting issue(s) and use critical thinking, judgment, and problem solving to take appropriate action.

• Identify opportunities to improve how we resolve claims and benefit issues, including improvements to InView,[KB1] our benefit content, and other tools and resources.

• Participate in special projects as requested.

• Provide colleagues with timely and accurate solutions to their client’s complex claims problems.

• Support of client expectations and health plan processing guidelines.

To be successful in this role, it is expected that you have:

• Excellent knowledge of English language, strong communication skills both in written and verbal

• Ability to work independently, organize, and prioritize own tasks effectively

• Previous experience in roles where technology, multi-tasking and verbal/written communication is used to drive their day-to-day responsibilities is an advantage

• General computer literacy